Low Overall Survival in Women With De Novo Metastatic Breast Cancer: Does This Reflect Tumor Biology or a Lack of Access to Health Care?

PURPOSE: As a result of its epidemiologic and therapeutic aspects, metastatic breast cancer (MBC) is a highly relevant clinical condition. This study aimed to estimate overall survival (OS) in women with de novo MBC in a Brazilian population. PATIENTS AND METHODS: Patients were identified in the Goiânia population-based cancer registry between 1995 and 2011. All women with metastatic disease at diagnosis were included in the study. OS was analyzed at 5 and 10 years of follow-up. We used the Kaplan-Meier estimator and Cox regression for statistical analysis. RESULTS: Over the 16-year period covered by the study, 5,289 women were diagnosed with breast cancer in Goiânia. Of these, 277 women (5.2%) had MBC. OS rates at 5 and 10 years were 19.9% and 7.3%, respectively. The mean OS time of women treated in the public health system was 7.5 months shorter than in women who had private health care (19.7 v 27.2 months, respectively). In the univariable analysis, the following factors were statistically significant for OS: T3/4 staging, histologic grade 3, progesterone receptor status, tumor phenotype, breast surgery, CNS metastasis at initial presentation, and surgery for resection of metastasis. In multivariable analysis, initial CNS metastasis (hazard ratio, 3.09; 95% CI, 1.16 to 8.19) and breast surgery (hazard ratio, 0.45; 95% CI, 0.25 to 0.78) remained independent prognostic factors. CONCLUSION: OS was lower than rates found in specialist centers in Brazil and in developed countries. Several intrinsic and extrinsic factors were significant in predicting OS. Despite the difference in the 5-year survival rate, the type of access to health care was not significant in the multivariable analysis of the entire period.

Molecular analysis of translocations associated with Ewing sarcoma: case report / Análise molecular de translocações associadas ao sarcoma de Ewing: relato de caso

ABSTRACT We report the case of a 25-year-old female patient having a large lesion in the right breast. The core biopsy revealed a high-grade fusocellular neoplasm. Immunostains show no evidence of a specific line of differentiation. The patient underwent radical surgery and adjuvant treatment. Due to the immunohistochemical profile and the rosette arrangement in fusocellular injury, a molecular evaluation of translocations associated to the Ewing sarcoma (ES) was made. However, translocations commonly associated with this disease [t(11;22)(q24;q12)] were not observed. The present report can contribute to the diagnostic investigation of similar cases and to the pre-test orientation of the molecular evaluation.

RESUMEN Presentamos el caso de una paciente de 25 años con lesión voluminosa en mama derecha. La biopsia de la lesión mostró neoplasia fusocelular de alto grado; la inmunohistoquímica no ha determinado la histogénesis de la lesión. La paciente fue sometida a la cirugía radical y al tratamiento adyuvante. Ante el perfil inmunohistoquímico y la formación en roseta de la lesión fusocelular, se ha realizado una evaluación molecular de translocaciones asociadas al sarcoma de Ewing (SE); sin embargo no han sido observadas translocaciones comúnmente asociadas a esa patología [t(11;22)(q24;q12)]. El presente reporte puede ayudar en la investigación diagnóstica en casos similares así como orientar la evaluación molecular.

RESUMO Relatamos o caso de uma paciente, 25 anos de idade, portadora de lesão volumosa em mama direita. A biópsia da lesão evidenciou neoplasia fusocelular de alto grau; a imuno-histoquímica não revelou a histogênese da lesão. A paciente foi submetida à cirurgia radical e ao tratamento adjuvante. Diante do perfil imuno-histoquímico e do arranjo em roseta em lesão fusocelular, foi realizada avaliação molecular de translocações associadas ao sarcoma de Ewing (SE); entretanto não foram observadas translocações comumente associadas a essa patologia [t(11;22)(q24;q12)]. O presente relato pode contribuir para a investigação diagnóstica de casos semelhantes, bem como para a orientação pré-teste da avaliação molecular.

Abdominal Adiposity and Physical Inactivity Are Positively Associated with Breast Cancer: A Case-Control Study.

OBJECTIVE: To examine whether breast cancer is associated with body composition and level of physical activity, considering the menstrual status. METHODS: This was a case-control study with 116 women recently diagnosed with breast cancer and 226 controls. Body composition was assessed by dual-energy X-ray absorptiometry, and cardiometabolic risk was assessed by conicity index and waist-to-height ratio. The short version of the International Physical Activity Questionnaire was used to estimate the level of physical activity. All analyses were adjusted for age and BMI. RESULTS: The total body fat percentage, android body fat, android-gynoid ratio, and waist circumference were positively associated (p < 0.05), whereas the percentage of lean body mass (p <0.05) and the level of physical activity (p < 0.01) were inversely associated with breast cancer in premenopausal women. Among postmenopausal women, physical activity decreased the chance of developing breast cancer by 49% (95% CI = 0.29 to 0.92, p = 0.02). CONCLUSION: A low percentage of lean body mass and high abdominal adiposity in the premenopausal period increase the chances of developing breast cancer. Regular physical activity is inversely associated with breast cancer in pre- and postmenopausal women.

The accuracy of the SONOBREAST statistical model in comparison to BI-RADS for the prediction of malignancy in solid breast nodules detected at ultrasonography.

OBJECTIVE: The objective of the present study was to compare the accuracy of SONOBREAST for the prediction of malignancy in solid breast nodules detected at ultrasonography with that of the BI-RADS system and to assess the agreement between these two methods. STUDY DESIGN: This prospective study included 274 women and evaluated 500 breast nodules detected at ultrasonography. The probability of malignancy was calculated based on the SONOBREAST model, available at www.sonobreast.com.br, and on the BI-RADS system, with results being compared with the anatomopathology report. RESULTS: The lesions were considered suspect in 171 cases (34.20%), according to both SONOBREAST and BI-RADS. Agreement between the methods was perfect, as shown by a Kappa coefficient of 1 (p<0.001). SONOBREAST and BI-RADS proved identical insofar as sensitivity (95.40%), specificity (78.69%), positive predictive value (48.54%), negative predictive value (98.78%) and accuracy (81.60%) are concerned. With respect to the categorical variables (BI-RADS categories 3, 4 and 5), the area under the receiver operating characteristic (ROC) curve was 94.41 for SONOBREAST (range 92.20-96.62) and 89.99 for BI-RADS (range 86.60-93.37). CONCLUSIONS: The accuracy of the SONOBREAST model is identical to that found with BI-RADS when the same parameters are used with respect to the cut-off point at which malignancy is suspected. Regarding the continuous probability of malignancy with BI-RADS categories 3, 4 and 5, SONOBREAST permits a more precise and individualized evaluation.

Effect of tamoxifen and raloxifene on the proliferative activity of the breast epithelium in premenopausal women.

OBJECTIVES: To compare the effects of tamoxifen and raloxifene on the proliferative activity of normal breast tissue in premenopausal women as measured by Ki-67/MIB-1 expression. STUDY DESIGN: A total of 48 women with benign breast nodules and a recommendation for surgical removal of the lesion took part in this study. They were randomized to use tamoxifen or raloxifene for 22 days, after which they were submitted to surgery. During the surgical procedure, a 1-cm fragment of normal breast tissue was removed to study Ki-67 expression. RESULTS: The mean percentage ratios between immunolabeled and non-labeled cells were 2.02 ± 1.09 and 3.13 ± 3.23 for the tamoxifen and raloxifene groups, respectively. There was no statistically significant difference between the tamoxifen (n = 16) and raloxifene (n = 14) groups in relation to the immunohistochemical analysis of Ki-67 (P = 0.205). CONCLUSION: The results of this study showed no difference between tamoxifen and raloxifene with respect to the potential of these drugs to reduce the proliferative activity of the normal breast epithelium in premenopausal women.

Incidence and risk factors for winged scapula after surgical treatment for breast cancer.

AIMS AND OBJECTIVES: To evaluate the incidence of winged scapula following surgical breast cancer treatment, determine its evolution over time and correlate factors that might influence this incidence. BACKGROUND: Winged scapula is a complication that may occur as a result of exposing the long thoracic nerve during axillary lymphadenectomy for the treatment for breast cancer. There is no consensus in the literature about the incidence of this complication after surgical treatment for breast cancer, and complication rates range from 1·5-74%. DESIGN: This is a prospective cohort study. METHODS: A prospective cohort study was conducted including 57 patients with breast cancer who underwent surgical treatment. Each patient was assessed before and after the surgery, by means of Hoppenfeld manoeuvre. The incidence rate of winged scapula was calculated at four different times. RESULTS: At the preoperative assessment, none of the patients presented with winged scapula, while 16 patients (28·1%) were shown to have this complication after the procedure. The incidence of winged scapula decreased over time. Factors associated with winged scapula were as follows: patients younger than 50 years, clinical stage I and II and no neoadjuvant chemotherapy. Other factors that were evaluated, such as type of surgery, number of lymph nodes compromised and removed, as well as body mass index, were not associated with the risk of winged scapula. CONCLUSIONS: This study demonstrated that the incidence of winged scapula is low and decreased over time. Furthermore, a greater incidence of winged scapula was noted in young women at an initial stage of the disease who had not been treated with neoadjuvant chemotherapy. RELEVANCE TO CLINICAL PRACTICE: The result of this work may have great impact, for demonstrating what risk factors are significantly associated with winged scapula after surgical treatment for breast cancer.